Orbital fracture

Background

• Water's view is 83% sensitive at detecting these.
• 10-20% have ocular injury. binocular diploplia from direct muscle injury resolves in 82%, but diploplia from entrapment requires surgical repair.
• Malignant emphysema and/or retrobulbar hemmorhage are emergencies requiring a lateral canthotomy.

Diagnosis

1. Eye
   1. Acuity, extraocular movements
   2. Blurry, double, or decreased vision?
   3. Pain with EOM?
2. Pupil
   1. Reactivity, size, shape
3. Globe
   1. Proptosis or enophthalmos?
   2. Increased intercanthal distance?
   3. Extrusion of intraocular contents?
4. Orbit
   1. Crepitus from fracture into sinuses?

Orbital CT Indications

1. Evidence of fracture on exam
2. Decreased extraocular mobility
3. Decreased visual acuity
4. Severe pain
5. Unable to perform adequate exam

DDX

• Orbital Hematoma
  • Proptosis, diffuse pain
• Ruptured Globe
  • Tear-shaped pupil
  • Extrusion of intraocular content
• Orbital zygomatic fracture
  • Most common
• Nasoethmoid fracture
  • Inspect for:
    • Damage to medial canthal ligament
    • Damage to lacrimal duct
    • Medial rectus entrapment
• Orbial Floor fracture
  • Inspect for:

1. Entrapment of inferior rectus
2. Enophthalmos
3. Damage to infraorbital nerve

• Retinal Detachment
• Hyphema
• Optic Nerve Shealth Hematoma

Treatment

• Azithromycin or augmentin
• Extraocular muscle entrapment
  • May result in oculocardiac reflex -> vagal symptoms
  • Consider release of entrapped muscle
• Decreased extraocular movement not due to entrapment
  • Consider corticosteroids
• Surgical indications include greater tha 2mm enopthalmos and/or persistent diploplia.

See Also

• Orbital Hematoma
• Ruptured Globe